Vaping-Associated Lung Injury 

Background

The Maryland Department of Health is investigating cases of individuals who have developed severe lung illness with no clear infectious cause after using e-cigarettes, or “vaping.” Similar cases have been reported in other states across the United States and are described on the CDC Webpage.

Cases of Vaping-Associated Lung Injury (as of November 5, 2019): 46

Symptoms of Vaping-Associated Lung Injury


Patients report using e-cigarettes or vaping in the weeks or months prior to the onset of symptoms. Respiratory symptoms reported include: shortness of breath, chest pain, pain on breathing, wheezing, coughing, and coughing up blood. Other symptoms reported by many patients include: fever, chills, nausea, weight loss, vomiting, diarrhea, or abdominal pain.


Detailed descriptions of this illness, and clinical guidance that may aid identification, can be found in recent publications in the New England Journal of Medicine and Morbidity and Mortality Weekly Report, and in additional clinical publications listed below in Guidance for clinicians.


Causes of Vaping-Associated Lung Injury

The cause of this cluster of illnesses is not known, and has not been definitively linked to any particular device, substance, or brand. People who became ill reported using a range of products, including both cannabis-derived products with THC or CBD, and nicotine-containing products


Frequently Asked Question for the Public

Q: What are e-cigarettes? What is vaping?

A: E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals. Users inhale the aerosol, including any additives, into their lungs. Commonly inhaled chemicals include nicotine, tetrahydrocannabinol (THC, the psychoactive component in cannabis/marijuana), cannabidiol (CBD, another chemical found in cannabis/marijuana), flavorings, and other additives like propellants, solvents, and oils. Vaping means using these products.

Q: How can I keep myself safe from vaping-associated lung illness?

A: The best way to keep yourself safe is to not use e-cigarettes or vapes.


Q: I heard this illness is caused by marijuana or THC oils. Is that true?

A: The strongest risk factor identified to date for this illness is vaping pre-filled catridges of cannabis-derivative products like  THC or CBD.  Maryland Department of Health strongly advises against the use of these products.  However, a definitive cause is not yet known, and some people who became sick do not report vaping THC or CBD.


Q: I only use THC or CBD oils made with natural ingredients and safe extraction techniques that come in sealed cartridges. Is that safe?

A: No product has yet been identified as safe, and there is no evidence to date that any set of ingredients or extraction techniques prevent this illness.  Most people who became sick used pre-filled va​ping cartridges that, to their knowledge, were not tampered with.   Additionally, information about ingredients or extraction techniques listed on packaging may not be accurate. Ingredients that may be safe when eaten or applied to skin may not be safe when vaporized or inhaled.


Q: I heard this illness is caused by Vitamin E. Is that true?

A: We do not know yet. Testing at several national labs has identified a compound – vitamin E acetate – in some, but not all, of the THC product samples collected from people who became sick. However, we do not know if Vitamin E acetate was the cause, or even one of several causes of the illness. There is also no way for you to test if a product you purchase contains vitamin E acetate or any other possibly harmful chemical.

Q: I’m enrolled in Maryland’s medical cannabis program. Should I stop or change what I’m using?

A: Persons enrolled in Maryland’s medical cannabis program who vape and are concerned about this illness can contact their medical provider to discuss the risks and benefits of the products they are using. If you start to experience any of the symptoms listed above, seek immediate medical attention. If you think you became sick because of medical cannabis, you should report the incident by e-mail to reporting.mmcc@maryland.gov.


Q:  If I only use Juul or other nicotine products, am I completely safe from lung injury?


A:  No product has been confirmed safe.  About one out of every ten people identified as developing lung injury after vaping report vaping only nicotine.  Additionally, there are other known and unknown health risks associated with using e-cigarettes or vaping nicotine, including risk of addiction - the best choice for your health is to not vape nicotine, and not smoke or use any tobacco product.


Q:  I want to quit using e-cigarettes and vaping but, I can't.  What should I do?


A:  If you want to stop using e-cigarettes, or any tobacco product, you can call the Quit Line at 1-800-QUIT-NOW:  Trained professionals are there 24/7 to help you.

Q:  I used e-cigarettes to help me quit smoking.  What should i do?

A:  Don't start smoking again.  There are several FDA-approved quit aids like nicotine patches, gum or lozenges that safely help smokers quit and reduce nicotine withdrawal.  Use these products instead of vaping to help you stay quit.  FDA-approved quit aids can be mailed to you for free through the Quit Line (see above), or by your local health department.

Q:  Where can I learn more about the health-effects of vaping?

A:  The Maryland Department of Health has a website for youth and young adults - TheVapeExperiment.com​ - that describes the known and unknown hazards with vaping and e-cigarette use.

Information for the Public

MDH Center for Tobacco Prevention and Control
Maryland Tobacco Quitline

FDA, Center for Tobacco Products
Know the Risks: E-cigarettes and Young People

CDC: Smoking and Tobacco Use

The Vape Experiment


Information for Clinicians

Secretary of Health Reporting Directive

MDH Clinician Update Letter (October 2, 2019)

MDH Clinician Letter on Vaping and Lung Injury (August 20, 2019)

Laboratory Clinical Specimen Collection and Storage Guidance
  for Lung Injury Related to e-Cigarette Related Exposures

NEJM Preliminary Report

MMWR Characteristics of Multi-State Outbreak of Lung Injury Associated with Vaping

    (September 27, 2019)

MMWR CDC Interim Guidance (September 13, 2019)

CDC Clinical Outreach Alert 

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